Individual
JENNY K PATRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2555 E 13TH ST, SUITE 130, LOVELAND, CO 80537-5113
(970) 663-5437
(970) 669-5762
Mailing address
1627 E 18TH ST, LOVELAND, CO 80538-4209
(970) 663-0135
(970) 461-1422
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
31289
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01312891
—
CO
05
—
0725580
—
IA
05
—
122742400
—
WY
01
—
841287602004
CHAMPUS
CO
01
—
PAP5937
ANTHEM BCBS
CO
05
—
XPY206315
—
CA
Enumeration date
11/22/2005
Last updated
11/22/2010
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